Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

Background The principles of global surgery should be taught as a part of the core curriculum in medical schools. The need for medical students to be familiar with the topic is increasing in acceptance. There is, however, a paucity of data on how medical students are exposed to global surgery. This study aims to evaluate exposure of medical students to global surgery, awareness of the key messages of the Lancet Commission on Global Surgery, global surgery career aspirations and barriers to said aspirations. Methods ISOMERS was a multi-centre, online, cross-sectional survey of final year medical students globally. The questionnaire utilised a combination of Likert-scale, multiple-choice, and free text questions. Results In this study, 1593 final year medical students from 144 medical schools in 20 countries participated. The majority (n = 869/1496, 58.1%) believed global surgery to be relevant, despite 17.7% (n = 271/1535) having any exposure to global surgery. Most participants (n = 1187/1476, 80.4%) wanted additional resources on global surgery. Difficulty in providing appropriate care for patients living abroad (n = 854/1242, 68.8%) was the most common perceived barrier to a career in global surgery. Conclusions Participants believed global surgery was a relevant topic for medical students and wanted additional resources that they could access on global surgery. It is critical for medical students to become aware that global surgery is a field that aims to address inequity in surgical care not just internationally, but nationally and locally as well.

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Background: Medical students present a high merit and potential source of blood in hospitals due to their medical knowledge, physiological potential by age however their use has been rarely described in southern Tanzania. Objectives: The main objective of the study was to assess the knowledge, attitude, willingness for the future blood donation among medical students of southern, Tanzania. Methods: A cross-sectional study to assess awareness, knowledge, attitudes, willingness and factors associated blood donation among medical students in Ruvuma, Southern Tanzania was conducted from March to June 2018. A self- administered questionnaire was used and data was analyzed by IBM Corp, SPSS Version 24.0. Results: A total of 176 students were assessed at an average age of 25.8 ± 3.6 years. Eighty medical students (45.5%) ever donated blood while among them 66 (82.5%) of those being out of volunteering. About 46 (57.5%) students had a repeated experience for blood donation. Majority of students had positive attitude toward blood donation 159 (90.3%), often 135 (77%) identified voluntary blood donation to be useful and 133 (75.6%) were willing to donate in the future. Factors that were significantly associated with blood donation were age above 30 (OR=0.18, p<0.001), male sex (OR=3.69, p=0.001), past HIV screening (OR=2.59, p=0.029), knowledge of one’s own blood group (OR=4.86, p<0.001,) and knowledge of the safe duration to donate a unit of blood (OR=2.42, p=0.024). Conclusion: Medical students present a high awareness, positive attitude, and high intention to donate blood to achieve the WHO goal for non-remunerated blood donation.

Introduction Medical students around the world have been showing an increasing interest in Global Surgery as evident by their participation in various organizations on local and international levels. We set out to evaluate exposure of medical students to global surgery, modes of exposure, whether the exposure meets the needs of students, awareness of the key messages of the Lancet Commission on Global Surgery, global surgery career aspirations and barriers to said aspirations. Methods We developed the International Survey Of Medical students Exposure to Relevant global Surgery (ISOMERS) study, an online, international, questionnaire-based study. This survey will collect data from final year medical students across the world. The questionnaire utilises a combination of the Likert scale, multiple choice options and free text questions and will be disseminated by email and social media through the International Student Surgical Network, a global surgery student interest group with more than 5,000 members. Results Primary outcomes will include exposure to global surgery research, advocacy and education among medical students. We will generate simple descriptive statistics and identify determinants of exposure among medical students and subgroups (country income class and geographic region). Also, we will use multinomial regression analysis to identify confounders and significant dependent variables. Conclusion The ISOMERS study will identify the level of exposure to global surgery among students during medical education. An understanding of this exposure will be crucial in developing the foundation for global surgery education at the level of undergraduate medical curriculum and furthered in addressing perceived barriers to joining the global surgery workforce.